Contents. May 2016 KYN Long Training 2

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2 Contents Impact of alcohol on health and the NHS. Department of Health guidance and associated risk of drinking above these levels. How to calculate units of alcohol. Direct health implications to the patient topics of discussion. Screening and brief intervention model FRAMES Increased knowledge of the signs of withdrawal and appropriate treatment pathways. Information, advice and help on alcohol for patients in the hospital and the community. May 2016 KYN Long Training 2

3 Facts about alcohol and how it impacts on health. All data relative to guidance prior to Jan 2016 Over 90% of adults drink alcohol in England. Approximately 8 million adults (approx. 1 in 4) consume above the Governments sensible drinking guidelines. Alcohol now the third leading cause of ill health in country after tobacco and blood pressure. Alcohol is the leading cause of death among 15 to 49 year olds (PHE alcohol evidence review) Excessive drinking causes over 60 medical conditions including strokes, cancers, heart disease, mental health problems and injuries requiring treatment. In Accident and Emergency department between midnight and 5am up to 70% attendances are alcohol-related. (SIPS Research Project, Kings College London 2015) May 2016 KYN Long Training 3

4 Alcohol, health and the NHS cont. In 2013/14, there were an estimated 1,059,210 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis. Of these the highest number of admissions, 511,260 (48 per cent of all admissions), were due to cardiovascular disease in 2013/14. In England, in 2013 there were 6,592 alcohol-related deaths, a 1% increase from 2012 (6,495) and a 10% increase from 2003 (5,984). For year olds, 26% of deaths in males and 23% of deaths in females have been attributed to alcohol consumption Source: From Health and Social Care Information Centre June 2015 May 2016 KYN Long Training 4

5 Alcohol, health and the NHS England 2013: 15% of men and 20% of women did not drink any alcohol in the last year. Of those who do drink; 18% of men and 13% of women drank at an increased risk of harm (more than 4 units for men, or 3 units for women, but less than double). 5% of men and 3% of women drank at higher risk levels (more than 8 units for men or 6 units for women a day or 50 or 35 units a week). Although drinking trends are going down, the impact of people s long term drinking and binge drinking (double the lower limit 6) over time is placing more demands on our National Health Service. May 2016 KYN Long Training 5

6 The estimated cost of alcohol harm To society is 21 billion per year. To NHS is 3.5 billion per year This is equal to 120 for every taxpayer. House of Commons Health Select Committee on the Government s Alcohol Strategy Third Report of Session May 2016 KYN Long Training 6

7 National guidance on alcohol consumption The Chief Medical Officer has guidance on alcohol consumption to reduce health harms. This is described in term the number of units. In addition the Royal College of Psychiatrists has given guidance (based on old guidelines) for older adults. May 2016 KYN Long Training 7

8 Chief Medical Officers guideline 2016 Men and Women: You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level If you do drink as much as 14 units per week, it is best to spread this over 3 days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries. The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis. If you wish to cut down the amount you re drinking, a good way to help achieve this is to have several drink-free days each week. May 2016 KYN Long Training 8

9 Unit consumption answers Adult Male and Female What do you think the recommended daily unit consumption is? 14 units per week spread over several days, with benefit of 2 or more alcohol free days A young person years Child under 15 Older adult 65+ Parents and young people should be aware that drinking, even at age 15 or older, can be hazardous to health and that not drinking is the healthiest option for young people. If 15 to 17 year olds do consume alcohol they should do so infrequently and certainly on no more than one day a week. Young people aged 15 to 17 years should never exceed recommended adult limits and on days when they drink, consumption should usually be below such levels. None Children and their parents and carers are advised that an alcohol-free childhood is the healthiest and best option, However, if children drink alcohol, it should not be until at least the age of 15 years Half the adult consumption May 2016 KYN Long Training 9

10 What does that mean? Men and Women 14 units per week spread over several days 6 pints of 4% ABV beer/lager/ale *Beck s Vier, Boddingtons, Carling, Carlsberg, Fosters, Guinness, John Smith s, Stella (low strength) 6 MEDIUM 175ml glasses of 12 % ABV wine. (most wine is between 12-15%) 10 May 2016 KYN Short Training 10

11 What does that mean? 5.5 Pints (568mls) 4.5% ABV Cider. Bulmers, Gaymer, Magners, Stella Cidre, Strongbow. 3.5 Pints (568mls) >7% ABV Cider. Old Rosie Scrumpy, Frosty Jacks and Diamond White. 14 Single measures (25ml) 40% ABV Vodka, Whisky 11 May 2016 KYN Short Training 11

12 Guidance on pregnancy If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk. Most women either do not drink alcohol (19%) or stop drinking during pregnancy (40%).37 The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy. Women who find out they are pregnant after already having drunk during early pregnancy, should avoid further drinking, but should be aware that it is unlikely in most cases that their baby has been affected. If you are worried about how much you have been drinking when pregnant, talk to your doctor or midwife. May 2016 KYN Long Training 12

13 Your turn! What do you think the recommended daily unit consumption is? Adult female Adult male A young person years Child under 15 Older adult 65+ May 2016 KYN Long Training 13

14 What is a unit and how do I calculate it? 1 unit = 8g/10ml of pure alcohol. To work out the units of different drinks use the following formula. Unit(s)= Here s an example %ABV x volume (ml) 1000 A pint of lager (ABV) 5.3% x (volume) 568 mls 1000 = 3 units May 2016 KYN Long Training

15 Your turn! Using the formula %ABV x Volume 1000 = UNITS calculate the following. 275mls 4.5% 125mls 12% 568mls 6.1% 25mls 40% 568mls 4.5% 175mls 14% May 2016 KYN Long Training

16 Unit answers Using the formula %ABV x Volume 1000 = UNITS calculate the following. 275mls 4.5% 125mls 12% 568mls 6.1% 25mls 40% 568mls 4.5% 175mls 14% 1.2 units 1.5 units 3.5 units 1 unit 2.5 units 2.3 units May 2016 KYN Long Training

17 Alcohol consumption and health The diagram gives an overview of the damage alcohol can do to someone s health. May 2016 KYN Long Training 17

18 Alcohol consumption and health continued Alcohol increases the risk of many medical conditions including heart attack, stroke, pancreatitis and high blood pressure. Cancer- Alcohol increases the risk of 7 types of cancer (liver, bowel, breast, mouth, pharyngeal, oesophageal and laryngeal cancer). Liver Disease Alcohol can cause inflammation in the liver, whether the heavy drinking is every day or just a few days a week. Over time scarring and cirrhosis can occur. Healthy liver, Fatty Liver, Cirrhotic Liver

19 Alcohol consumption and health continued Medical Information When you reduce your drinking short term effects of alcohol can improve; sleeplessness, stress, memory loss, sweating, shaking, loss of appetite, stomach problems, anxiety, diarrhoea, sickness, bad skin and weight gain. Weight gain - Alcohol contains lots of calories, almost as many as pure fat! nhs.uk//livewell/alcohol/pages/calories-in-alcohol.aspx May 2016 KYN Long Training 19

20 Risk of illnesses from alcohol consumption

21 Alcohol health harm For female Breast Cancer, relative risks of both illness and death from the disease increase: by 16% if drinking regularly at 2 units (16 grams) per day (equivalent to the proposed guideline level) by 40% if drinking regularly at 5 units (40 grams) per day (more than double the proposed guideline level) An estimated 6 per cent of female breast cancers in the UK are linked to alcohol, that effects more than 3,000 women each year For Cirrhosis of the Liver, for men, relative risks of death from the disease increase: by 57% if drinking regularly at 2 units (16 grams) per day (equivalent to the proposed guideline level by 207% if drinking regularly at 5 units (40 grams) per day (more than double the proposed guideline level) May 2016 KYN Long Training 21

22 Alcohol health harm For Ischaemic Stroke, for men, relative risks of death from the disease: decrease by 11% if drinking regularly at 2 units (16 grams) per day (equivalent to the proposed guideline level increase by 3% if drinking regularly at 5 units (40 grams) per day (more than double the proposed guideline level) For Cardiac Arrhythmias, for men, relative risks of illness and death from the disease increase: by 13% if drinking regularly at 2 units (16 grams) per day (equivalent to the proposed guideline level increase by 34% if drinking regularly at 5 units (40 grams) per day (more than double the proposed guideline level) 22 May 2016 KYN Long Training 22

23 Alcohol risk levels MEN WOMEN Lower Risk Increasing Risk Higher Risk Binge Drinking Less than 14 units a week spread evenly across 3 or more days units per week. More than 50 units per week (or more than 8 units per day on a regular basis Consuming more than twice the lower risk levels in one day (> 8 units) Less than 14 units a week spread evenly across 3 or more days units per week. More than 35 units per week (or more than 6 units per day) on a regular basis Consuming more than twice the lower risk levels in one day (>6 units) Alcohol Dependence Drinking behaviour characterised by an inner drive to consume alcohol, continued drinking despite harm and commonly withdrawal symptoms on stopping drinking May 2016 KYN Long Training 23

24 Benefits of reducing alcohol Reduced risk of liver disease Reduced risk of cancer Better physical shape Reduced risk of injury Save money Reduced risk of drink driving Improved memory No hangovers More energy Lose weight Better sleep Improved mood Improved relationships Depression / Anxiety May 2016 KYN Long Training 24

25 When can you drive after drinking? Calculate your units From the moment you stop drinking the first hour does not count and then it takes an hour for every unit drunk to be metabolised. Example 5 pints at 4% = 11.3 units. Stop drinking at 11pm therefore can get behind a wheel of a car until am. May 2016 KYN Short Training 25

26 What does this tell us? Not many drinks are a single unit! Pouring drinks without a measure makes it difficult to keep track of units If a person drinks alcohol s/he needs to be able to calculate his/her units (go to the Know Your Numbers campaign and how this relates to national consumption guidance (DoH) As a member of staff you can educate patients about units. Why is this important? May 2016 KYN Long Training 26

27 Why we need to ask about alcohol: An opportunity to raise awareness Alcohol related physical harm is entirely preventable Preventing the complications of withdrawal Impact on NHS As health care professionals we have multiple opportunities to screen and provide advice. May 2016 KYN Long Training 27

28 Who says so? Chief Medical Officer, DoH: It is vital that nurses have up-to-date advice on alcohol guidelines and the skills to have conversations about alcohol consumption all nurses play a significant role in stopping the rising tide NICE Clinical Guidance CG115: Staff working in services provided and funded by the NHS who care for people who potentially misuse alcohol should be competent to identify harmful drinking and alcohol dependence. They should be competent to initially assess the need for an intervention or, if they are not competent, they should refer people who misuse alcohol to a service that can provide an assessment of need May 2016 KYN Long Training 28

29 AUDIT C Alcohol screening Questions How often do you have a drink containing alcohol? How many units of alcohol do you drink on a typical day when you are drinking? Scoring system Never Monthly or less 2-4 times per month 2-3 times per week times per week Your score How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? Never Less than monthly Monthly Weekly Daily or almost daily May 2016 KYN Long Training 29

30 Audit scores what next? Scores 0-4 Indicates a low risk drinker who is less likely to develop alcohol related problems. Congratulate! Audit C positive scores 5 12 Indicates increasing or higher risk drinking, which could put ones health at risk in the future. Deliver brief intervention. Patients who score 8 or above should be referred to the Alcohol Specialist Nurse Team. Following AUDIT score many patients will require brief intervention. May 2016 KYN Long Training 30

31 Brief intervention An Alcohol Brief Intervention (ABI) is: The giving of information, advice and encouragement to the patient to consider the positives and negatives of their drinking behaviour. In addition offer support and help to the patient if they do decide they want to cut down on their drinking or sign post to alcohol support services. (Alcohol Harm Reduction Strategy for England pg. 37) For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels. 56 controlled trials have shown the value of brief intervention (Moyer et al, 2002) May 2016 KYN Long Training 31

32 FRAMES approach F eedback- risk R esponsibility- individual A dvice- reduction M enu of options to change E mpathy S elf efficacy- be self aware of changes. SIPS (Screening and Intervention Programme for Sensible Drinking) Alcohol Learning Centre May 2016 KYN Long Training 32

33 What is withdrawal Alcohol withdrawal is the set of symptoms seen when an individual reduces or stops alcohol consumption after prolonged periods of excessive alcohol intake. The withdrawal is largely due to the central nervous system being in a hyper-excitable state. Withdrawal symptoms can be classified into three categories: *mild *moderate *Severe Mild alcohol withdrawal can cause pain and suffering and severe alcohol withdrawal can be life-threatening. Even mild or moderate withdrawal can be dangerous for those people with hypertension or heart conditions as withdrawal can raise blood pressure further. May 2016 KYN Long Training 33

34 Visual signs of withdrawal Vomiting Tremor Sweating Anxiety Agitation (fidgety and restless) Tachycardia Seizures May 2016 KYN Long Training 34

35 Reported signs of withdrawal Nausea Headaches Disorientation/confusion Tactile disturbance (itchy, pins and needles, numbness or crawling under the skin) Auditory disturbance (more aware of noises, sounds are harsh or frightening, hearing things that are not there) Visual disturbances (lights brighter, colour different, seeing things that are not there) May 2016 KYN Long Training 35

36 Wessex AHSN Brief Treatment Pathway May 2016 KYN Long Training 36